Pain Modalities Used in Physiotherapy

March 12, 2019 | By | Reply

– Dr. Ketki A Bhosle

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. In simple terms it’s a highly unpleasant physical sensation caused by illness or injury or sometimes it is present without actual damage too.

In Physical therapy we deal a lot with pain. With physical therapy, there are many active treatments (joint mobilizations, therapeutic exercise, etc) and electrical modalities are as follows ,that when used together can be a powerful tool for stopping pain.


  • Ultrasound refers to mechanical vibrations merges with sound waves with higher frequency used to treat many musculoskeletal conditions like sprains, strains, or tendonitis. High frequency sound waves that promote in relieving pain and muscle spasms and improve circulation.
  • In ultrasound, a hand-held transducer is moved in a circular motion over an injured area. A small amount of gel is used so the ultrasound waves are absorbed into the skin and muscles.
    Phonophoresis is a therapy that combines ultrasound and topical medications.
    This medication (anti-inflammatory) is applied directly to skin and ultrasound waves are used to help pass the medicine through the skin and then into injured body part.
    It is used to decrease pain and inflammation.


  • Electrical stimulation, is the general term for several modalities that involve electrodes attached to a patient’s skin. These modalities can be used for both pain relief and functional improvements, even in cases involving neurological disorders. Electrical Stimulation causes muscles to contract and relax for relief of spasm and pain and muscle strengthening.
  • Commonly referred to as TENS, Transcutaneous electrical nerve stimulation is used to manage acute and chronic pain.
  • TENS works on pain gate mechanism. In the gate control theory of pain, pain messages travel from the periphery of the body through nerve “gates” in the spinal cord and up to the brain. Non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from travelling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain.

It helps in re-education of the injured muscle like Bell’s Palsy, Foot drop
in which its effective in facilitating functional movements.



  • This is an effective therapy used for pain relief and accelerate the self healing process, getting body back to a healthy and pain free state.
  • It also helps in muscle contraction.
  • The four electrodes are positioned around the target area so that each channel runs perpendicular to the other and the current crosses at a midpoint, in the shape of a four-leaf clover, which can cover larger surface area. Tissues within this area receive the maximal treatment effect.


  • This therapy is used in stimulating motor nerves. It allows stronger muscle contractions which can be used to strengthen muscles and muscle re- education.
  • It can also be used to stimulate analgesic effect in the muscle making it effective in reducing pain.


  • Moist heat is another form of superficial heat therapy.
  • Heat increases blood flow and makes connective tissue more flexible.
  • It temporarily decreases joint stiffness, pain, and muscle spasms.
  • Heat therapy is used to treat various forms of arthritis, muscle spasm.


  • Ice is usually used during the acute or initial phase of injury to limit localized swelling around tissues.
  • Unlike heat, cold or ice therapy is used to reduce blood flow and inflammation during the acute phase of healing.
  • It can also reduce or temporarily prevent swelling in an injured joint or muscle following exercise.
  • In many cases, first apply heat to help patients “warm up” and gain mobility for therapeutic exercise, and apply ice to reduce the inflammatory response afterwards.



  • Passively moving the joints in a specific direction is referred to as joint mobilization.
  • Apart from working like hinges, joints also glide on one another while moving.
  • Joint mobilization helps with decrease in pain intensity and improves joint mobility, like in frozen shoulder patients.



  • Massage is using the hands to knead the injured tissues of your body to help decrease pain, improve circulation, and decrease muscle tension.
  • There are many massage techniques, including effleurage, petrissage, and trigger point massage.



Kinesio taping is used in acute or rehab program for better prognosis. It may be used for various functions, which may include:

  • To inactivate or off -load overused muscles
  • Muscle activation
  • swelling management
  • Pain relief

Kinesiology tape is applied to the skin, and it can be kept in place for a few days.


Dry needling is a form of Acupuncture where, needles are inserted in trigger points (palpable nod or a band like hardness found in muscles ) or motor points. Putting a needle into a tight muscle causes the muscle to relax.

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We at PHYSIOREHAB do a detailed evaluation to get specific clinical diagnosis which helps us implement these treatment procedures.
The modalities used may vary from patient to patient, but always follow clinical reasoning.

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